Search PubMed⌕ Search

Biomedical subjects

Steven R Feldman

Publications and source records attributed to Steven R Feldman.

At least 109 records · Page 6Linked to original sources
PubMed2004

Adherence to topical therapy decreases during the course of an 8-week psoriasis clinical trial: commonly used methods of measuring adherence to topical therapy overestimate actual use.

INTRODUCTION: Medication nonadherence is common throughout medicine, and research into this area is increasing; however, knowledge about topical medication adherence is limited. METHODS: A total of 30 patients were enrolled in a clinical trial for psoriasis and followed up for 8 weeks using 3 methods of adherence monitoring: electronic monitoring caps; medication logs; and medication usage by weight. RESULTS: Adherence rates calculated from the medication logs and medication weights were consistently higher than those of the electronic monitors (P <.05). Electronically measured adherence rates declined from 84.6% to 51% during the 8-week study (P <.0001). Female sex and increasing age by 1 year predicted improved adherence of 5% and 0.8%, respectively (P <.0001). The number of treatment gaps increased from the first half to the last half of the study, and weekend days were overrepresented in treatment gaps. CONCLUSION: Medication logs and weights do not ensure medication adherence to topical therapy. Electronic monitoring allows a more precise method of adherence measurement.

Administration, Topical↗
PubMed2004

Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners.

BACKGROUND: Investigations into tanners' reasons for tanning have focused primarily on the perception of improved appearance. Reported relaxing effects of tanning suggest the possibility of a physiologic effect of UV that drives tanning behavior. OBJECTIVE: We sought to determine if there is a physiologic reinforcing effect of UV exposure, separate from appearance motivation, that may contribute to tanning behavior. METHODS: We determined the reinforcing effect of UV light in a series of controlled, blinded, repeated-choice trials of UV carefully designed to separate as cleanly as possible reinforcing effects of UV exposure from other factors including perceived benefits of having a tan. A total of 14 young adults who used tanning beds regularly were exposed to otherwise identical UV and non-UV tanning bed stimuli on Mondays and Wednesdays for 6 weeks. On Fridays, participants had concurrent access to the two beds. The primary dependent variable was the percentage of choice sessions during which more UV than non-UV tanning was chosen. RESULTS: In all, 12 participants chose additional tanning exposure on Fridays and, of these, 11 consistently used the UV bed for that exposure. Of the total 41 occasions when participants chose to tan on Friday, 39 sessions (95%) were for the UV bed and only two for the non-UV bed. A more relaxed and less tense mood was reported after UV exposure compared with after non-UV exposure (P=.008 and P=.002, respectively). DISCUSSION: When exposed to UV and non-UV under blinded conditions, frequent tanners can distinguish the two conditions and undertake further UV exposure, indicating that UV is a reinforcing stimulus. The relaxing and reinforcing effects of UV exposure contribute to tanning behavior in frequent tanners and should be explored in greater detail.

Adult↗
PubMed2004

Determinants of quality of life in patients with psoriasis: a study from the US population.

BACKGROUND: Psoriasis is a common disease with substantial effects on quality of life. Few quality of life studies have been performed in psoriasis patients from the general US population. OBJECTIVE: To describe the determinants of quality of life in psoriasis patients from the US population. METHODS: Patients were randomly selected from the US population. Patients who identified themselves as having been diagnosed with psoriasis by a physician were invited to complete a more detailed survey about quality of life. RESULTS: Two hundred sixty-six psoriasis patients from the US population completed the detailed survey. Body surface area showed the strongest association with decrements in quality of life (Spearman 0.50, P < .0001). Younger patients and female patients also had statistically significant reductions in quality of life. Increasing psoriasis severity was associated with seeking care from multiple physicians and having decrements in income. CONCLUSION: Patients with more extensive skin involvement have greater reductions in quality of life. Female patients and young patients are affected to a greater extent.

Age Factors↗
PubMed2004

Tacrolimus ointment is effective for facial and intertriginous psoriasis.

BACKGROUND: Intertriginous and facial involvement are manifestations of psoriasis that require a different approach than is used for typical plaque psoriasis on other skin areas. Topical corticosteroids are the primary treatment for psoriasis; however, the side effects of corticosteroids are magnified on intertriginous and facial skin. Topical tacrolimus offers the potential for anti-inflammatory effect without the atrophy or other local side effects associated with the use of topical corticosteroids. OBJECTIVE: To determine the efficacy and tolerability of 0.1% tacrolimus ointment for the treatment of facial or intertriginous psoriasis. METHODS: One hundred sixty-seven patients 16 years or older were evaluated in an 8-week, randomized, double-blind, vehicle-controlled, multi-center study. Upon entry into the study, patients were randomized 2:1 to apply the tacrolimus ointment 0.1% or vehicle twice daily to all psoriatic lesions of the face or intertriginous areas for 8 weeks. The physician's global assessment was used to assess improvement from baseline. The inverse psoriasis severity for patients was measured using a 6-point scale from clear to very severe. RESULTS: As early as day 8, more patients ( P = .004) had cleared or achieved excellent improvement in the 0.1% tacrolimus ointment group compared to the vehicle group (24.8% vs 5.8%). At the end of the 8-week treatment period 65.2% of the tacrolimus ointment group and 31.5% of the vehicle were clear or almost clear ( P < .0001) based on a Static Severity Score. Adverse events were similar in the 0.1% tacrolimus ointment and vehicle groups. Conclusion Tacrolimus ointment is an effective treatment for psoriasis of the face or intertriginous areas.

Adolescent↗
PubMed2004

Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction.

The impact of psoriasis on quality of life has been studied in select patient populations. Population-based data detailing the distribution of extent of disease, associated problems in everyday life, and treatment satisfaction for the US population have been lacking. Our population-based survey indicates that approximately 4.5 million adults have been diagnosed as having psoriasis. Most (59%) have little or no involvement, but 650,000 adults have at least three palms of body surface involved and more than 1,000,000 indicate substantial dissatisfaction with their treatment. Only 5% of patients (56,000) who report severe dissatisfaction with current therapy have extensive disease (10 palms). Many individuals with little psoriasis at the time of interview considered the disease to be a large problem in everyday life.

Adult↗
PubMed2004

Seasonal variation of dermatologic disease in the USA: a study of office visits from 1990 to 1998.

BACKGROUND: Seasonal variation has been demonstrated in many diseases, including certain skin diseases. OBJECTIVE: To determine whether there is seasonal variation in dermatologic office visits in the USA. METHODS: Data on dermatologic office visits were obtained from representative visits to outpatient physicians in the USA from the National Ambulatory Medical Care Survey from 1990 to 1998. Office visit seasonality was examined for all skin conditions, and individually for the 15 most commonly diagnosed conditions. RESULTS: Office visits for skin conditions were seasonal (P = 0.002). The magnitude of variation can be roughly expressed by the following scheme: actinic keratosis (P = 0.0001) > acne (P = 0.0001) > folliculitis (P = 0.002) > dyschromia (P = 0.01) > seborrheic keratosis (P = 0.04) > psoriasis (P = 0.07) > seborrheic dermatitis (P = 0.09). Visits for skin cancer, not otherwise specified (skin cancer NOS), atopic dermatitis, cysts, common wart, wart, not otherwise specified (wart NOS), rosacea, contact dermatitis, and benign tumors showed no significant seasonal variations or trends. CONCLUSIONS: Dermatologic office visits are seasonal, with visits for individual diseases varying in their magnitude of seasonality. This seasonal variation may be a result of biological and nonbiological variables.

Humans↗
PubMed2004

The promise and challenge of new biological treatments for psoriasis: how do they impact quality of life?

Psoriasis disrupts a patient's work, play, and relationships and impacts how patients view themselves. These effects are measured through the concept of quality of life. The most central feature of the concept of HRQL (health-related quality of life) is that it represents the patient's perspective, helping understand the full impact of the illness on patients' lives. Psoriasis causes a high level of physical impairment, social impairment, emotional distress, occupational interference, and disruptions in leisure activities. HRQL can be measured with a variety of instruments that are acceptable to patients and have demonstrated adequate psychometric properties (e.g., reliability, validity, and sensitivity to change). These include global, skin-specific, and psoriasis-specific measures. Although generic measures are useful in comparing the impact of psoriasis to that of other diseases, skin-specific and psoriasis-specific measures are more sensitive to the impact of the disease and are useful in demonstrating the impact of treatment on the lives of patients with psoriasis. These measures have been used to show the benefits new biologic medications offer our patients.

Alefacept↗
PubMed2004

Patients spend more time with the physician for excision of a malignant skin lesion than for excision of a benign skin lesion.

BACKGROUND: Currently, there is a difference in reimbursement between excision of malignant and benign lesions. There is concern that there is not sufficient rationale for differential reimbursement for these two procedures. OBJECTIVE: To assess whether there is a difference in physician work involved with excision of benign versus malignant skin tumors. METHOD: We searched National Ambulatory Medical Care Survey data for visits at which excision of benign and malignant skin lesions was performed. We compared the time spent with the physician at these two types of visits. To exclude confounding issues unrelated to the excision that would affect the time of visit, we excluded visits at which multiple diagnoses were addressed. RESULTS: The mean time spent with the physician at visits for excision of benign lesions was 22.9 +/- 1.0 minutes. The mean time spent with the physician at visits for excision of malignant lesions was 30.0 +/- 1.7, 30% longer (p<0.001). The longer time for excision of malignant lesions remained significant after controlling for age, gender, and race. CONCLUSION: Excision of malignant lesions involves more physician work than does excision of benign lesions. Elimination of differential compensation for benign versus malignant skin lesion procedures would not enhance the accuracy of reimbursement. In the absence of any compelling rationale to change the existing differential reimbursement, the proposals to do so are not warranted.

Episode of Care↗
PubMed2004

Why are there differences in the perceived safety of office-based surgery?

BACKGROUND: Office-based surgery has become an important method of health-care delivery, but there is controversy about its safety and which practitioners should perform it. Several states have already or are preparing to enact legislation regulating office-based surgery. OBJECTIVE: The objective was to discuss recent literature pertaining to the safety of office surgery and to discuss reasons why there are perceived differences in its safety. METHODS: The pertinent literature is reviewed. Results. The majority of studies suggest that office surgery is safe. A recent study that found to the contrary may have methodologic flaws. CONCLUSION: The medical and legislative community should seek to scientifically examine office surgery. Overregulation or loss of office surgery would have a tremendous impact on the management of skin cancers and the delivery of quality cosmetic and laser surgery.

Ambulatory Surgical Procedures↗
PubMed2004

Lower adverse event and mortality rates in physician offices compared with ambulatory surgery centers: a reappraisal of Florida adverse event data.

BACKGROUND: A recent study using Florida adverse event data found an increased risk of mortality in offices as opposed to ambulatory surgical centers. A major limitation of Florida adverse event data is the lack of uniform collection of the number of cases performed. OBJECTIVE: The objective was to reassess the risk of mortality from physician office and ambulatory surgical center procedures using improved estimates of the numbers of cases performed in these settings. METHODS: Adverse incident reports from March 2000 to March 2003 were obtained from the Florida Board of Medicine. We used data from the National Ambulatory Medical Care Survey and from the Medicare Current Beneficiary Survey to estimate the number of office procedures in Florida for both the general and the Medicare populations. The number of procedures performed and the number of deaths in ambulatory surgical centers was obtained from the Florida Agency of Healthcare Administration for the years 2000 through 2002. These data were used to calculate adverse event and mortality rates. RESULTS: For physician offices, the adverse event rates and mortality rates calculated per 100,000 procedures from National Ambulatory Medical Care Survey data were 2.1 and 0.41, respectively, and 0.24 and 0.10 using Medicare Current Beneficiary Survey data. For ambulatory surgical centers, the mean adverse event rate was 4.4 and the mean mortality rate was 0.90. DISCUSSION: Florida's adverse event data do not show higher adverse event rates in physician offices compared with ambulatory surgical centers. Incident reporting and public availability of incidents are important, as is standardization of reporting rules for both adverse events and number of procedures performed in different settings.

Ambulatory Surgical Procedures↗
PubMed2004

Over-the-counter topical skin products--a common component of skin disease management.

Over-the-counter (OTC) products are widely recommended by physicians and utilized by the public for the treatment and prevention of disease. The use of OTC drugs has been studied extensively, but the patterns of physician recommendations for OTC topical skin products and the characteristics associated with patients receiving such recommendations remain unclear. We aimed to look at patterns of OTC topical skin product recommendations by physician specialty, patient demographics, geographical region, diagnosis, and metropolitan status to determine whether there are differences in the utilization of these products in the treatment of dermatologic conditions. We analyzed office-based physician visits for OTC topical skin product recommendations recorded in the 1995 to 2000 National Ambulatory Medical Care Survey (NAMCS). From 1995 to 2000, there were an estimated 36 million physician recommendations for OTC topical skin products. Although dermatologists were responsible for 53.8% of recommendations, pediatricians had the largest proportion of recommendations per prescription recommendation (OTC/Rx=0.58). Women patients, white patients, patients younger than 20 years, urban residents, and those living in the Southern United States received greater numbers of OTC topical skin product recommendations. Of the leading products recommended, hydrocortisone (27.6%), anti-infectives (23.4%), and moisturizers (13.4%) were the most common. OTC topical skin product recommendations by US physicians are substantial, particularly among dermatologists and primary care physicians. Physician specialty, gender, race, and age appear to be factors associated with those recommendations.

Adolescent↗
PubMed2004

Hyperpigmentation: an overview of the common afflictions.

Hyperpigmentation disorders of the skin are common. Three of the more common forms include melasma, lentigines, and post-inflammatory hyperpigmentation. Significant negative psychological consequences can result. Many therapeutic options exist, though treatment is often difficult, requiring lengthy therapy.

Chemexfoliation↗
PubMed2004

The cost of psoriasis therapies: considerations for therapy selection.

PURPOSE: The purpose of this article is to provide a review of the cost of psoriasis therapies from two sources as well as compare the average wholesale price (AWP), as listed in the 2003 Drug Topics Red Book to that of a popular Internet pharmacy. METHODS: Prices of therapies were obtained two ways: the AWP was recorded from the 2003 Drug Topics Red Book. A range and average price per gram (or mL) were calculated based on the smallest size or quantity available. In addition, a price comparison was made to values as they were reported online at drugstore.com. Monthly cost estimates were based on average systemic dosing and for topicals, 18 g/month (for 1% body surface area [BSA] involvement). RESULTS: The prices of psoriatic treatment medications vary considerably--from the relatively inexpensive topical corticosteroids to the more costly biologic therapies. In the category of corticosteroids, a trend was evident between the overall price per gram of each class and the potency of each class. Class I and VI corticosteroids had an average price per gram (or mL) of dollars 2.08 (dollars 37/month/1% BSA) and dollars 0.86 (dollars 15/month/1% BSA), respectively. Nonsteroidal topical treatments had an average price per gram (or mL) dollars 2.18 (dollars 39/month/1% BSA). Systemic therapies have a wide range of costs. The total monthly expense, based on estimated average dosing, was calculated for methotrexate, acitretin, and cyclosporine and were dollars 78.60, dollars 400.50, and dollars 735.00, respectively. Biologic therapies designed for continuous use cost roughly dollars 1,300/month. DISCUSSION: There are numerous treatment options for psoriasis with a wide range of costs. In addition to significant challenges from a scientific perspective, psoriasis treatment is further complicated by the cost of the numerous medications. Prices reported in the AWP were similar in many instances to those listed at an Internet pharmacy. Many considerations should go into therapy selection for psoriasis and a comprehensive approach that includes cost will likely provide the best patient care.

Anti-Inflammatory Agents↗
PubMed2003

The importance of skin disease as assessed by "willingness-to-pay".

BACKGROUND: To achieve optimal resource allocation in health care, it is necessary to value competing resource uses according to the benefit derived from those uses. Skin disease makes as great an impact as other serious medical conditions when assessed by effects on health-related quality of life. OBJECTIVE: To confirm the high impact of skin disease by comparing patients' willingness to pay (WTP) to be cured or relieved from symptoms of skin and nonskin conditions. METHODS: We searched the published literature on WTP to compare the impact of dermatologic conditions with the impact of other medical conditions. A total of 46 articles were identified of which 10 included information on willingness to pay for cure reported on a monthly basis. RESULTS: WTP for skin diseases fell in the range of 125-260 dollars/month and was comparable or higher than all but one of the other identified conditions. CONCLUSION: Willingness to pay for relief from skin diseases is comparable to that for relief of other serious medical conditions. Skin diseases are associated with a significant adverse impact on patients' lives.

Cost-Benefit Analysis↗